| NPI | 1205252426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN B TATE Owner 502-454-7871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: KY 39021) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2014-03-12 |